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Which price and who determines it?
I would think that hospitals could create price schedules similarly to how other businesses do. Although I imagine this gets really messy when dealing with Medicare and with the mandate to treat everyone regardless of their ability to pay. I'd expect those arrangements would need to change to make this work. I feel a bit silly pontificating about this. Hopefully someone who really understands the topic will weigh in.
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This seems so sensible to me that I’m curious why the hell it wouldn’t work.
Which price and who determines it?
Healthcare pricing should be based on cost+plus models for the hospitals rather than on value driven approach you see every else in any sales.
We are not questioning their costs whatever they maybe, if the costs logically remain roughly same no matter how a particular patient came to them, then there is no reason for price to be different depending on type/ nature of insurance or lack thereof.
> “What we’re learning from the hospital data is that insurers are really bad at negotiating” Do the insurers have any incentive to negotiate well? Since their customers are not very price-sensitive (since they aren't marketing directly to patients or doctors), I would imagine they don't have a huge incentive to do anything but apply a markup to whatever prices the hospital tells them it costs.
If insurers’ customers were not price sensitive, then they would have higher profit margins than 5%.
Building contractors are an example of an industry that runs on razor thin profit margins in % turnover terms, because all they’re doing is passing on the cost of labour and materials from their suppliers and subcontractors onto their clients and just making their profit adding value in a thin management layer. Which sounds a lot more analogous to insurers than industries that earn 5% profit on their turnover.
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I mean, that seems like peak Big Government Overreach, but to each their own. Alternatively, people could quit buying wholly inappropriate vehicles. If your job requires you to carry lots of cargo around, then a pickup makes a lot of sense. If you drive a spotless Ram 2500 that never leaves the suburb, then I don't want to hear a damn thing about the price of gasoline. And even if you personally don't drive an idioti…
Those cars produce less carbon than your vacation halfway across the globe and aren't used purely for recreational purposes. It seems like carbon really isn't your issue here.
For anyone looking to download the data, here are a few links: Empire Blue (Anthem): https://www.empireblue.com/machine-readable-file/search/ United Healthcare: https://transparency-in-coverage.uhc.com/ Aetna (Seems like the right page, but I don't see any download links — possibly because they haven't been posted yet): https://health1.aetna.com/app/public/#/one/insurerCode=AETNA... Search keywords: https://www.googl…
So are there programs I can use to parse this? It looks like a json file with links to more gziped json files...
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Those cars produce less carbon than your vacation halfway across the globe and aren't used purely for recreational purposes. It seems like carbon really isn't your issue here.
I haven't gone on a distant vacation in many years, so not I'm not sure why you're bringing that up. But yes, a suburban-dwelling, daily commuter Expedition is absolutely a recreational choice, and an irresponsible one at that.
Just like air travel. If making one unaffordable is positive, why not the other?
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What's reference-based pricing?
It's basically price-controls. A regulatory body looks at how much something "should" cost based on its history of reimbursement and the cost of its inputs and then sets a cap of say, cost + 20%. The problem is having an independent body that is free of influence of health insurance companies and hospitals, both of which have perverse incentives to continue profiteering.
> “What we’re learning from the hospital data is that insurers are really bad at negotiating” Do the insurers have any incentive to negotiate well? Since their customers are not very price-sensitive (since they aren't marketing directly to patients or doctors), I would imagine they don't have a huge incentive to do anything but apply a markup to whatever prices the hospital tells them it costs.
The Affordable Care Act introduced the newer perverse incentive of insurance companies tolerating higher prices. Because if you can only pay your execs bonuses based on 20% of your total spend, insurance companies can pay execs more if the underlying claims they're paying cost more. 20% of a $1,000 MRI isn't as juicy to your C levels as 20% of a $10,000 MRI.
All insurance companies, all of them are corrupt. The whole system needs to be burnt down. PPOs are the worst, I wish HMOs were the norm, but that won't fix everything.
Further reading: https://www.investopedia.com/terms/m/medical-cost-ratio.asp
I'm one of the co-founders of Turquoise Health, mentioned in the article here. We've been downloading and parsing this data all day. It's a really big deal in the industry that the prices that insurance companies pay doctors are now being shared publicly. It will have all sorts of positive impacts over time, hopefully making rate negotiations more consistent and fair between different insurance plans. Right now, 10x…
Makes me wonder how things got to this point. How can a business perform any planning if they sell their services with such big differences between prices charged to customers?